OBJECTIVE: To assess the value of proximal gastrectomy (PG) and total gastrectomy (TG) for the treatment of cancer of cardia and fundus. METHODS: Publications on comparision between PG and TG in the treatment of cancer of cardia and fundus were collected, the data from the publications were matched with the PG group and the TG group respectively according to its corresponding surgical resection, and the data on postoperative complications, motality and 5-year survival rate were meta-analyzed by fixed effect model and random effect model. RESULTS: Thirteen reseaches on 2 219 patients were included in this study, 2 of which were randomly controlled studies. There were no significant differences in the postoperative complications (OR=1.00, 95%CI: 0.44-2.28,P>0.05) and mortality (OR=1.25, 95%CI: 0.62-2.48,P>0.05) between the PG group and the TG group, while there was significant difference in the 5-year survival rate (HR=0.87, 95%CI: 0.76-0.99,P=0.04). The 5-year survival rate in the TG group was higher than that in the PG group. CONCLUSION Total gastrectomy for the treatment of cancer of cardia and fundus has better long-term therapetic effect.
Cardia ; pathology ; Gastrectomy ; methods ; Gastric Fundus ; pathology ; Humans ; Prognosis ; Stomach Neoplasms ; mortality ; surgery ; Survival Rate

BACKGROUND: Gastric polyps encompass a wide variety of lesions that most commonly arise from the gastric epithelium. However, coincidental gastric carcinomas have rarely been reported, being found in 1.5~2.1% of patients with hyperplastic polyps. The sizes and the pathologies of polyps seem to be important in the application of treatment. Therefore, it is necessary to classify gastric polypoid lesions after a gastrectomy. MATERIALS AND METHODS: During a follow-up endoscopy study, 23 patients were found to have developed gastric polyps after a gastrectomy. Most of those polyps were removed by using an endoscopic polypectomy. We performed clinical and pathologic evaluations of the gastric polyps in the remainding in the stomach after a gastrectomy. RESULTS: The mean age of the patients was 64.5 years old with the incidence of polyps remainding in the stomach after a gastrectomy increasing after the first year following the gastrectomy. The sizes of the polyps ranged from 0.3 cm to 3.5 cm in diameter and the numbers of polyps below 1.0 cm were 19 (82.6%). The anastomotic site was the most prevalent place 10 (43.2%), followed by the cardia 6 (26.0%) and the body 4 (17.3%). Among 23 gastric polypoid lesions Yamada types of gastric polyps in the remainding in the stomach were as follows: 1 case in type I, 12 cases in type II, 9 cases in type III, 1 case in type IV. The pathologic diagnoses of the polyps were hyperplastic polyps in 6 cases, tubular adenomas in 2 cases and inflammatory polyps in 15 cases. CONCLUSION: Endoscopic polypectomy is believed to be important in assessing the precise diagnosis of gastric polyps remainding in the stomach. In this study, hyperplastic polyps were found to have no malignant potential, despite their sizes. As a result aggressive biopsy with a polypectomy of gastric polyp after gastrectomy is recommended and frequent follow-up be performed.
Adenoma ; Biopsy ; Cardia ; Diagnosis ; Endoscopy ; Epithelium ; Follow-Up Studies ; Gastrectomy* ; Humans ; Incidence ; Pathology ; Polyps* ; Stomach*

BACKGROUND/AIMS: Endoscopic mucosal resection (EMR) of early gastric cancer (EGC) or gastric flat adenoma has been widely accepted as a useful method due to its minimal invasiveness and satisfactory post- procedure results in maintaining a good quality of life for patients. The purpose is to define the long-term effect and usefulness of EMR of EGC and gastric flat adenoma. METHODS: We analysed, retrospectively, 101 lesions in 96 cases that could be followed-up were analyzed. Endoscopic surveillance with histological examination was carried out every three months for one year after the treatment, every six months for the second year, and annually thereafter. RESULTS: 1) The mean follow-up period was 17.7 months (1-78). 2) Of the 101 lesions, there were 6 recurrences (5.9%), the mean period was 17.3 months (2-37). One of 28 EGC, five of 73 gastric flat adenoma showed recurrence. 3) The recurrence rate tended to be higher in as the size increased (p=0.06). In the lesions which were resected by planned piecemeal, 10% of those lesions recurred (4/40), while 3.3% (2/61) of those lesions recurred in which lesions were resected en bloc (p=0.21). 4) With respect to location of the primary lesions, the recurrence rate was higher in the lesions of the cardia (50%, p<0.05). CONCLUSIONS: We concluded that the size and location of the lesions were related to recurrence after EMR, but sex, pathology, and resection methods were not related.
Adenoma* ; Cardia ; Follow-Up Studies* ; Humans ; Pathology ; Quality of Life ; Recurrence ; Retrospective Studies ; Stomach Neoplasms*

While endoscopic submucosal dissection (ESD) is widely used to treat gastrointestinal tumors, it is rarely used for subepithelial tumors (SETs) originating from the muscularis propria of the esophagus and gastric cardia because of the risk of perforation and problems with inadequate space and field of view during procedures. Submucosal tunneling endoscopic resection (STER) is a new therapeutic method for treating SETs in specific locations in the esophagus and stomach. This technique is highly skill-dependent, using a mucosal flap that covers a deeper part of the gut wall, but is safe and minimally invasive compared with conventional endoscopic approaches such as ESD in SETs originating from the muscularis propria.We report a patient who underwent STER to remove a SET located at the gastric cardia. The patient recovered without any complications. We believe that our case shows the efficacy and safety of the STER technique for patients with a SET originating from the muscularis propria.
Cardia/pathology/surgery ; Endosonography ; Gastric Mucosa/pathology/surgery ; Gastroscopy ; Humans ; Leiomyoma/*diagnosis/surgery ; Male ; Middle Aged ; Stomach Neoplasms/*diagnosis/surgery

Adenocarcinoma ; pathology ; Carcinoma, Squamous Cell ; pathology ; Cardia ; Esophageal Neoplasms ; classification ; pathology ; Esophagogastric Junction ; pathology ; Humans ; Neoplasm Staging ; Stomach Neoplasms ; classification ; pathology

BACKGROUND/AIMS: Stomach cancer can be easily diagnosed via endoscopy, but also possible to be missed. The aim of this study was to investigate the clinical and endoscopic characteristics of advanced gastric cancers that were not diagnosed based on endoscopic examination. METHODS: We evaluated patients who had newly diagnosed advanced gastric cancer that was undetected via endoscopy within the last six months. RESULTS: Sixteen patients were included in this study. The locations of the cancers were the cardia in six cases, the greater curvature side of the body in eight cases and the antrum in two cases. The histological findings were tubular type adenocarcinoma in 11 cases, with ten cases of moderately to poorly differentiated adenocarcinoma and five cases of signet ring cell type adenocarcinoma. CONCLUSIONS: Even advanced gastric cancer lesions may not be detected during endoscopy. If a patient continues to complain of upper gastrointestinal symptoms, even though endoscopy does not find abnormal findings, repeated endoscopy and/or additional diagnostic studies should be considered.
Adenocarcinoma/*diagnosis/pathology ; Adult ; Aged ; Cardia/pathology ; Diagnostic Errors ; Female ; Gastroscopy ; Humans ; Male ; Middle Aged ; Prognosis ; Pyloric Antrum/pathology ; Stomach Neoplasms/*diagnosis/pathology

Adenocarcinoma ; classification ; genetics ; pathology ; surgery ; Cardia ; Esophageal Neoplasms ; classification ; genetics ; pathology ; surgery ; Esophagogastric Junction ; pathology ; Humans ; Lymphatic Metastasis ; Neoplasm Invasiveness ; Stomach Neoplasms ; classification ; genetics ; pathology ; surgery

The occurrence of multiple primary cancers associated with the esophagus and stomach is a well known phenomenon. However, the majority of those lesions are located apart each other. Finding of esophageal cancer and gastric cancer occurring simultaneously at the esophagogastric junction is extremely rare. In this case, the endoscopic findings showed that the cancer of the gastric cardia had invaded to the lower esophagus, but after the operation, the pathology report show the synchronous occurrence of esophageal squamous cell carcinoma and gastric adenocarcinoma. Therefore, we report here on a rare case of double primary cancer, and this double primary cancer occurred at the esophagogastric junction of a 67 year-old woman.
Adenocarcinoma ; Aged ; Carcinoma, Squamous Cell ; Cardia ; Esophageal Neoplasms ; Esophagogastric Junction* ; Esophagus ; Female ; Humans ; Pathology ; Stomach ; Stomach Neoplasms

OBJECTIVETo study the biological behavior of cardial cancer and its influence on surgical management.

METHODSComplete clinicopathologic data of 46 cases with cardial cancer undergoing radical gastrectomy was investigated retrospectively. The relationships between tumor Borrmann type, depth of invasion, growth pattern, lymph node metastasis and 5-year survival rate postoperative were analyzed.

RESULTSOf 46 cases, Borrmann type III, Type IV and Type II was 76% (35/46), 18% (8/46) and 6% (3/46) respectively; 5-year survival rate was 40% (14/35), 0 (0/8) and 100% (3/3) respectively. In respect of the depth of invasion, pT(2) was 31% (14/46) cases with 71% (10/14) lymph node metastasis; and 5-year survival rate was 64% (9/14). pT(3) was 15% (7/46) cases with 86% (6/7) lymph node metastasis; and 5-year survival rate was 57% (4/7). And pT(4) was 54% (25/46) cases with 92% (23/25) lymph node metastasis; and 5-year survival rate was 12% (3/25). The growth pattern in 87% (40/46) cases was infiltrative; and 5-year survival rate was 28% (11/40); the growth pattern in 13% (6/46) cases was expansive; and 5-year survival rate was 100% (6/6).

CONCLUSIOND(2)(+) radical total gastrectomy should be performed on the developed cardial cancer, and if necessary, resection of body and tail of pancreas should be chosen.

Aged ; Aged, 80 and over ; Cardia ; Female ; Humans ; Lymphatic Metastasis ; Male ; Middle Aged ; Neoplasm Invasiveness ; Prognosis ; Stomach Neoplasms ; pathology ; surgery

OBJECTIVETo evaluate total gastrectomy for the treatment of cancer of the cardia and stomach fundus.

METHODSFive hundred and thirteen patients with cancer of the cardia and stomach fundus underwent radical resection. Of them, 326 were treated using total gastrectomy (group TG); and 187, using proximal gastrectomy (group PG). The 5-year and 10-year survival rates and the postoperative complication rate and mortality rate were followed up and compared in the two groups.

RESULTSThe 5-year and 10-year survival rates of group TG were 43.6% and 24.5%, of group PG were 33.9% and 14.1%, respectively, and the difference was statistically significant (chi(2) = 4.421, P < 0.05, chi(2) = 5.726, P < 0.05). The postoperative complication rate and mortality rate of group TG were 14.7% and 3.1%, of group PG were 10.2% and 2.1%, respectively, and the difference was not statistically significant (chi(2) = 1.796, P > 0.05, chi(2) = 0.082, P > 0.05).

CONCLUSIONSTo improve long-term therapeutic effects, total gastrectomy should be recommended for stage III patients with cancer of the cardia and stomach fundus when tumor size is bigger than 3.0 cm or lymph node metastasis occur. The postoperative complication rate and mortality rate should not be increased and the esophagitis of gastroesophageal reflux should be avoided in the patients treated using total gastrectomy.

Adult ; Aged ; Cardia ; Female ; Gastrectomy ; Gastric Fundus ; Humans ; Lymphatic Metastasis ; Male ; Middle Aged ; Stomach Neoplasms ; mortality ; pathology ; surgery ; Survival Rate